In accordance with 5 CFR 1320, the information collection is not approved at this time. Prior to publication of the final rule, the agency should provide to OMB a summary of all comments received on the proposed information collection and identify any changes made in response to these comments.
Inventory as of this Action
Requested
Previously Approved
05/31/2014
36 Months From Approved
05/31/2014
52
0
52
1,976
0
1,976
0
0
0
Section 1923(a)(2)(D) of the Act requires the States to submit an annual report that identifies each DHS payment under the State's Medicaid program in the preceding fiscal year and the amount of DSH payments paid to that hospital in the same year and such other information as the Secretary determines necessary to ensure the appropriateness of DHS payments. The information supplied will satisfy the requirements under section 1923(a)(2)(D) of the Act as well.
There are proposed changes to the burden based on the a notice of proposed rulemaking (CMS-2367-P) that would require the submission of additional information under section 1923(j)(1) of the Social Security Act. To ensure the most accurate burden estimate, there are changes to the hours and wages based on our review of State submissions under section 1923(j) of the Social Security Act. Additionally, the number of respondents has been corrected from 52 to 51 (all 50 states and the District of Columbia).
Hours
The information submitted by each State is required annually, beginning at the end of the first quarter of the fiscal year following the reporting period. The notice of proposed rulemaking (CMS-2367-P) would require additional information hospital specific payment data from States related to the disproportionate share hospital program. We estimate that it would take an additional 4 hours per state (from 38 approved hr to 42 total hr) to complete the DSH reporting spreadsheets.
Wages
We used the following hourly labor rates and estimated the time to complete each task: $51.00/hr and an additional 102 hr (1,071 total hours) for management and professional staff to review and prepare reports, and $28.77/hr and an additional 102 hr (1,071 total hours) for office staff to prepare the reports. We estimate that the proposed changes will require an additional cost of $10,404 (or $85,434 total) based on the additional 204 (4 x 51) annual hours for all states and the District of Columbia (or 2,142 total hr).
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form CMS-R-266 Medicaid Disproportionate Share Hospital Annual Reporting
CMS-R-266 - Crosswalk.doc
Medicaid Disproportionate Share Hospital Annual Reporting